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Introduction: Multiple systems are available for chemo-mechanical preparation during pulpectomy, but an evolution of the exclusive paediatric rotary single file system has opened new doors in paediatric endodontics. The aim was primarily to compare the quality of obturation and instrumentation time and secondarily to report pain perception between manual files and rotary file systems in deciduous molars. Materials and Methods: Pulpectomy was performed in 60 carious mandibular primary molars indicated for pulpectomy in children aged 4–8 years after considering the selection criteria. These teeth were divided randomly into three groups of 20 each, wherein canals were prepared using Hand K files in Group 1, HeroShaper Rotary File System in Group 2 and Kedo S Square single paediatric rotary file in Group 3. The quality of obturation was assessed using intraoral radiographs, and instrumentation time was recorded in seconds using a stopwatch. Pain during instrumentation was assessed using Wong Baker's FACES Pain Scale. Collected data were subjected to analysis using the Chi-square test, one-way ANOVA and Honestly Significant Difference post hoc test. Results: Mean instrumentation time was least for the Kedo-S Square file system (57.47 ± 9.26), followed by the HeroShaper group (99.6 ± 23.62), and maximum time was recorded for Hand files (255.99 ± 46.20), and this difference was statistically significant (P = 0.00), whereas there was no significant difference regarding the quality of obturation and pain perception between the three groups. Conclusion: As the Kedo S Square system showed the fastest canal preparation, it can be recommended for pulpectomy procedures in primary teeth because the length of appointment is directly proportional to the behaviour of the child.

Background: Irrigation plays a pivotal role in pulp therapy owing to its flushing action and removal of the smear layer which if present prevents penetration of medicaments and sealers into the dentinal tubules. Aim: This study aims to evaluate and compare the smear layer removal potency of three commercial Irrigating agents. Materials and Methods: Single rooted 30 teeth were selected, decoronated, and randomly divided into three groups according to the irrigation regime to be used (Group I − 5% sodium hypochlorite [NaOCl] + ethylenediaminetetraacetic acid [EDTA], Group II – Chloraxid Gel + EDTA, Group III – Tween Kleen + 3% NaOCl). After recommended biomechanical preparation and irrigation, teeth were stained with 1% methylene blue dye for 24 h and sectioned in 2 halves. Stereomicroscopy was used to assess dye penetration and scanning electron microscope (SEM) analysis was done to detect dentinal surface changes. Data were analyzed using one-way ANOVA test and Tukey honestly significant difference test by statistical software SPSS version 20.0. Results: The highest dye penetration exhibiting smear layer removal for the apical third was seen in Group II (44.78) and for the middle third in Group I (64.73) which was statistically significant. SEM analysis showed maximum dentinal tubules visibility and patency in Group I and minimum in Group III. Conclusion: Newer irrigating materials (1-hydroxyethylidene-1, 1-bisphosphonate) exhibited weak potency for smear layer removal. The sequential use of gold standard NaOCl + EDTA gave satisfactory results, however, in apical third NaOCl Gel + EDTA was found to be more effective. Therefore, it can be prudent to use NaOCl Gels as a safer alternative to conventional means.

Background: Minimally invasive techniques should be employed to maintain pulp vitality without affecting physiological tooth resorption for pediatric patients. This study aims to evaluate clinical and radiographic success of light cure calcium silicate and resin-modified glass ionomer (RMGI) as indirect pulp-capping agent in primary molars in children between 5 and 9 years. Materials and Methods: In this randomized clinical trial study, 40 primary molars with the International Caries Detection and Assessment System criteria 4–6 score were divided randomly into two groups after computerized randomization method. After caries excavation by minimally invasive dentistry principle, affected dentin was lined by either light cure calcium silicate (Group I) or RMGI (Group II) liner followed by composite restoration. Clinical success was determined with the absence of symptoms and bitewing radiographs were taken at baseline, 3, and 6 months' interval to measure increase in dentin increment using ImageJ software. Statistical analysis for intergroup comparison was done using Paired t-test, and Independent t-test was used for intragroup comparison. The level of statistical significance was set at P < 0.05. Results: Change in dentin increment seen from baseline to 6 months in Group I was 0.19 mm and in Group II was 0.20 mm (P = 0.924). Intragroup increment was statistically significant during all follow-up intervals for both the groups (Group I – P ≤ 0.001, Group II – P = 0.009). For baseline remaining dentin thickness >1.5 mm, statistically significant increase was observed in the dentin increment at 3 months' interval between both the groups. Conclusion: Both TheraCal LC and Vitrebond show acceptable clinical and radiographic results when used in primary molars as indirect pulp treatment agents. Both the liners are equivalent to each other in terms of feasibility and cost-effectiveness but TheraCal LC can be preferred due to better handling and avoiding the manipulation step thereby reducing treatment time.

Background: Inguinal hernioplasty is one of the most commonly performed surgical procedures associated with moderate to severe postoperative pain. Optimal postoperative analgesia is important to prevent negative outcomes. The Ultrasound guided transversus abdominis plane (TAP) block is a peripheral nerve block that involves innervations of the anterolateral abdominal wall derived from T6-L1 which increases duration of analgesia & prolongs the time to first analgesic request, reduces postoperative analgesic consumption and reduces opioids related side effects. Various adjuvants to bupivacaine have been used to extend the analgesic effect. Most commonly used are dexmedetomidine, clonidine, dexamethasone and fentanyl. In this study we used clonidine and fentanyl. Primary objective was to assess the duration of postoperative analgesia while secondary objectives were to compare the quality of analgesia as measured by VAS score, the total amount of rescue analgesics consumed in 24 hours, side effects, and complications if any between the adjuvants. Aims and Objectives: To assess the duration of postoperative analgesia with clonidine v/s fentanyl as adjuvant to bupivacaine (p). To compare the quality of analgesia as measured by Visual Analogue pain scale (VAS) score, the total amount of rescue analgesics consumed in 24 hours and side effects and complications if any between the adjuvants Materials and methods: An observational hospital based study was conducted at Gandhi Medical College, Bhopal comprising of 60 patients between age group 18-60 years, male, belonging to ASA grade I to II, scheduled for elective bilateral inguinal hernioplasty under the subarachnoid block (SAB) after informed consent. GROUP C (B+C) - 30 patients received bilateral TAP block using 22 ml solution--consisting of 20 ml 0.25% bupivacaine and 1 mcg/kg clonidine dissolved in 2 ml normal saline. GROUP F (B+F) - 30 patients received bilateral TAP block using 22 ml solution--consisting of 20 ml 0.25% bupivacaine and 1 mcg/kg fentanyl dissolved in 2 ml normal saline. Diclofenac 75mg was used as rescue analgesia. Post operative pain is evaluated by VAS score for pain at 0,2,4,8,12 and 24 hrs postoperatively, time to 1st analgesia, total analgesia and any complications were noted. Result: There was no statistical significant difference between the two groups in demographic characteristics (age and ASA), The overall p value of mean heart rate, mean systolic bp, mean diastolic bp between 2 group is less than 0.001, the difference was statistically significant which means the average hemodynamic parameter values of group F (B+F) were greater than group C (B+C), The VAS score of group C Was significantly lower than VAS score of group F during all the intervals of time (p<0.001), Significant difference was seen in post-operative Ramsay sedation score at 2 hour, at 4 hours, at 8 hours, between GROUP F and GROUP C (p value <0.05). GROUP F has higher Ramsay sedation score, No significant difference was seen at 12 and 24 hours (p value > 0.05), between GROUP F and GROUP C, time to 1st rescue analgesia is longer in group clonidine, Total analgesic consumption in the group C was lower compared to that of group F which was significant statistically(p < 0.05). The incidence of hypotension and bradycardia more in group C. Other adverse effects were comparable. Conclusion: Addition of clonidine to Bupivacaine in TAP Block prolongs the post-operative analgesia than fentanyl. It provides longer first analgesia request time and less total analgesia consumption with minimal side effects. Addition of fentanyl to Bupivacaine in TAP Block gives more hemodynamic stability. [ABSTRACT FROM AUTHOR]

Background: An increasing embracement of safer regional techniques as pivotal components of multimodal analgesia regimen has made fast-tracking possible following pediatric cardiac surgery. Speaking of fasttracking in pediatrics, the feasibility of on-table extubation (OTE), and its' potential benefits are also being ardently researched with simultaneous emphasis on appropriate patient selection and adequate perioperative safety. Case Series: We report eight consecutive pediatric cases featuring a combination of serratus anterior plane block (SAPB) or erector spinae plane block (ESPB) to general anesthesia (GA) for patent ductus arteriosus (PDA) ligation through a left thoracotomy incision. Following induction of GA, the left-sided SAPB was performed in five patients and the other three patients received left-sided ESPB, each with 0.5 mL/kg of 0.2% ropivacaine. Demonstrating a mean intraoperative fentanyl requirement of 3.25 ± 0.71 μg/kg, OTE could be successfully contemplated in all the 8 patients. Subsequently, the post-operative face, leg, activity, cry, and consolability (FLACC) score was recorded at 1, 2, 4, 6, 8, and 12 h. Meanwhile, all the patients depicted acceptable pain scores till 4 h, administration of 0.5 μg/Kg rescue fentanyl was necessitated in three patients each at 6-h and 8-h postoperatively (given FLACC scores ≥4), amounting to a mean 0.375 ± 0.23 μg/kg post-operative fentanyl requirement. All patients received intravenous paracetamol at 8-h postoperatively. No block-related complication or need for reintubation was discovered. Conclusion: Incorporation of fascial plane blocks (SAPB or ESPB) to the conduct of GA for PDA ligation, allowed for safe OTE in our experience, due to an opioid-sparing potential. [ABSTRACT FROM AUTHOR]

Introduction: Individuals leaving against medical advice (AMA) are at risk for adverse health outcomes including a 40 percent increased mortality rate a year after self-discharge. Additionally, leaving AMA may dramatically increase medical costs due to failure to complete treatment resulting in higher risk of readmission with additional co-morbidities. Methods: Retrospective study of inpatients utilizing the Healthcare Cost and Utilization Project (HCUP) 2012 National Inpatient Sample (NIS) database. Primary outcome of interest was discharge type (AMA versus non-AMA) examined against primary payer type, patient and hospital characteristics. Analysis performed on the weighted discharges using Proc Surverylogistic. Statistical significance set at p less than 0.05. All analysis was performed in SAS version 9.4 (SAS Institute). Results: After adjustment for possible cofounders and socioeconomic factors, there were increased odds of leaving against medical advice in those that lacked insurance (ORadj = 4.16, p less than 0.001) or had Medicare (ORadj = 2.10, p less than 0.001) or Medicaid (ORadj = 2.94, p less than 0.001). Compared to individuals in the lower income brackets, groups with higher incomes had a 20-30 percent decrease in leaving AMA. However, in comparison to white individuals, black (ORadj = 1.023, p = 0.2688) and Native Americans (ORadj = 0.994, p=0.9322) were not at an increased risk of leaving AMA. Hispanic (ORadj = 0.665, p less than 0.001) and the Asian/Pacific Islander (ORadj = 0.56, p less than 0.001) groups had decreased odds of leaving AMA. Conclusion: Groups at risk for leaving AMA were individuals lacking insurance, having public insurance, and those within the 0-25th percentile in income. Although ethnicity does play a factor in leaving against medical advice, our data indicates that the gap is not as extreme as previously stated. Additional work needs to be done to help health care providers set targeted preventative measures to address those at increased risk for leaving AMA in order to provide a higher standard of care for the patient. [ABSTRACT FROM AUTHOR]

Objectives: To examine emergency department (ED) visits for mental health concerns by American Indian children in a multicenter cohort. To analyze demographic and clinical factors, the types of mental health concerns, and repeat mental health visits.Study Design: Cross-sectional study of children 5-18 years old who visited 1 of 6 EDs in the Upper Midwest from June 2011 to May 2012 and self-identified as white or American Indian. Mental health visits were identified by primary diagnosis and reasons for visit and were categorized into diagnostic groups. We explored racial differences in ED visits for mental health, diagnostic groups, and repeat mental health visits. Analysis involved χ(2) tests, Cochran-Mantel-Haenszel tests, and regression models including age, triage, timing, and insurance, and their interactions with race.Results: We identified 26 004 visits of which 1545 (5.4%) were for a mental health concern. The proportion of visits for mental health differed by race and age. American Indian children had lower odds of a mental health visit for 5-10 year olds (OR, 0.40; 95% CI, 0.26-0.60), but higher odds for 11-17 year olds (OR, 1.62; 95% CI, 1.34-1.95). In the older age group, American Indian children were seen primarily for depression and trauma- and stressor-related disorders, whereas white children were seen primarily for depression and disruptive, impulse control, and conduct disorders. Repeat visits were not different by race.Conclusions: Differences were noted in mental health visits between American Indian and white children and were influenced by age. These findings warrant further investigation into care-seeking patterns and treatment for mental health in American Indian children. [ABSTRACT FROM AUTHOR]